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August 1997 Volume 7, No. 8
IN THIS ISSUE
HEALTH WATCH
Taking the Bite Out of Malaria
LITERATURE REVIEWS
Women's Changing Roles
The Threat of "Lifestyle Diseases"
Disaster Relief: What Went Wrong?
ORGANIZATIONS
Tropical Agriculture
VITA PROJECTS
Reaching Out to Women in Morocco
ANNOUNCEMENTS
Emerging Infectious Diseases
Education For Development
* * *
DevelopNet News is published monthly by Volunteers in Technical
Assistance (VITA) in Arlington, Virginia, USA. For additional
information, please see the end of this newsletter.
* * *
H e a l t h W a t c h
TAKING THE BITE OUT OF MALARIA
In the tropical night, the whine of mosquitoes is often more than merely
annoying. It can threaten illness and even death from malaria. However,
new studies by the World Health Organization (Geneva) show that mosquito
nets treated with an insecticide can keep mosquitoes away and thus pro-
tect against malaria -- the deadliest of infectious diseases. The chem-
ical, called a pyrethroid, is cheap and harmless to humans.
Profile of a Killer
Malaria is caused by minute parasitic organisms known as plasmodia that
enter the red corpuscles in the blood and destroy them. It is transmit-
ted by the bite of the Anopheles mosquito and characterized by chills,
fever, and sweating. The disease is constantly present in 91 countries,
with about 40% of the world's population at risk. It directly affects an
estimated 300 to 500 million people a year and causes more than a mil-
lion deaths. More than 90% of its victims live in tropical Africa, where
it causes 15% to 25% of all deaths of children under the age of five.
Malaria is especially dangerous for young children who are not immune
and who also are likely to suffer from other parasitic diseases and
malnutrition.
Experts have tried to estimate the "costs" of malaria. These figures are
partly based on time lost when a person is unable to work because of the
disease. If the average time lost is 10 days a person-year, the annual
"cost" of malaria (including lost productivity, health care, and treat-
ment) for Africa can be estimated at $1,800 million.
This estimate says nothing about family productivity "lost" when a work-
er's relatives must do his work when he is ill. The average reduction in
the agricultural productivity of a household during the period of heavy
malaria transmission can be as much as 30%. The estimates also say
nothing about the decreased ability of sick children to learn in school
(35% to 60% of the children may be affected in some areas), or about the
effects on pregnant women and their babies, since malaria causes sub-
stantial number of miscarriages and babies born underweight.
Battling Malaria
Indoor spraying with DDT has eliminated or reduced the disease in many
countries. In other tropical areas it prevails as the world's leading
killer among infectious diseases. The use of insecticides, mosquito
nets, and drugs that attack the malarial parasite in the blood have all
been effective up to a point.
A malaria vaccine under development is not likely to be available for at
least five years; in this period 2,000,000 to 5,000,000 African children
can be expected to die from malaria.
In spite of global efforts, the incidence of malaria has risen steadily
in the last two decades. Here are the main reasons: (1) the deadly spe-
cies of the malarial parasite, Plasmodium falciparum, has rapidly
evolved greater resistance to chloroquin, the drug most used for preven-
tion and treatment; (2) in poor countries, there are shortages of essen-
tial drugs, supplies, health care skills, and control tools; (3) urbani-
zation has encouraged mosquito breeding in densely populated areas; (4)
malaria is closely related to economic development, as in road construc-
tion projects in Papua New Guinea and the gold-mining frenzy in Brazil;
and (5) it is favored by social crises, including the mass migrations of
the world's 14.5 million refugees.
In 1967, the World Health Organization said malaria could not be eradi-
cated, but might be controlled in some world areas. But it is curable
and preventable.
Mosquito Nets: An Effective Weapon?
Surprisingly, the latest weapon -- mosquito nets -- is not new. Indeed,
mosquito nets were used in Japan and China more than 1,000 years ago.
The World Health Organization itself has been promoting their use for
close to two decades. Why, then, are nets suddenly "in the news?" The
reason: recent WHO field studies show spectacular benefits from treating
the nets with insecticide. The benefits could be comparable with global
successes in the immunization programs for tuberculosis, measles, and
polio.
The extensive studies "involved half a million people and 20 research
institutes and donors," says WHO's Jacqueline Cattani. They focused on
Burkina Faso, The Gambia, Ghana, and Kenya, testing "the use of nets in
different areas with [greatly differing] malaria risks." The studies
required highly precise census, statistical, and chemical procedures
performed in the field. Nets (usually polyester) impregnated with
pyrethroid (half a gram per square meter of net) were used to cover
beds, windows and doorways. Using nets reduced malaria-related deaths by
16% to 33% especially among young children. In Kenya, the nets not only
saved lives but also led to a 40% decrease in hospital admissions for
severe malaria, showing that treated nets can reduce the cost of health
services. A different study in Afghan refugee camps located in Pakistan
showed a reduction in malaria infection of 87%.
Despite these findings and the wide use of treated nets throughout the
world, their use is still rare in Africa. Although most people have
heard of mosquito nets, only one in 20 uses them except near swamps and
irrigation dams or channels, where mosquitoes seem more aggressive. Part
of the reluctance to use nets may be cost-related. Nets are said to cost
between $5 and $10, plus $0.50 to $1.00 per year thereafter to re-treat
with the insecticide. WHO estimates that Africans spend up to $65 (or a
fifth of their income) on such items as antimalarial drugs, insecticide
sprays, and coils to suppress the disease, treat mosquito bites, and
repel mosquitoes. But people often find the cost of a net to be too
high, even though using them would bring better health and increase
productivity.
Mapping a Strategy
The technology of insecticide-impregnated nets shows great promise. How
does WHO plan to spread the word about the benefits and promote their
use? According to Igor Rozov, "the goal of the [African] trials was to
provide ministries, program managers, and funding agencies with reliable
data on the cost and effectiveness of insecticide treated nets." This
goal was met: the data persuaded African health ministers to endorse the
use of treated nets. The challenge now is to improve the technology for
treated net production and increase the access to them, the demand for
them, and their affordability, especially in Africa. These goals are
appropriate for WHO and other donors.
Accordingly, WHO has set up a Task Force, which has set these
priorities:
-- improving nets and their combination with insecticides;
-- finding the best ways to distribute nets, possibly through nongovern-
mental organizations, governmental primary health-care units, the pri-
vate sector, and "social marketing;" that is, marketing informed by
anthropology and other social sciences; and
-- establishing guidelines for timely re-treatment of the nets with
insecticide.
Meanwhile, WHO plans three more studies on the effectiveness of nets to
be completed by the end of 1997. They will focus on China, India, and
Myanmar. WHO also expects to conduct studies on the affordability of
nets, especially in Africa, and on lowering their cost by having them
manufactured locally.
Information: Vicki Tsiliopoulos <mailto:vickit@vita.org>.
L i t e r a t u r e R e v i e w s
WOMEN'S CHANGING ROLES
Sidney Ruth Schuler, Syed Mesbahuddin Hashemi, and Ann P. Riley, 1997.
"The Influence of Women's Changing Roles and Status in Bangladesh's
Fertility Transition: Evidence From a Study of Credit Programs and
Contraceptive Use." World Development, volume 25, no. 4 (April), pages
563-575.
In Bangladesh, women's lives are severely constrained by the traditions
of a patriarchal society and by extreme poverty. Still, over the last 25
years, contraceptive use has increased from 3% to 45% and fertility has
decreased from 7 births per woman to 3.4. These changes have not been
accompanied by changes in "traditional measures of economic development"
and were usually attributed to the government's family planning program.
But during the same period there was rapid growth of private-sector,
microcredit programs for women. In this study, the authors analyzed the
interactions among the prevalence of contraceptive use, membership in
microcredit programs, and women's empowerment.
Can "empowerment" be measured? The authors define empowerment by combin-
ing measures of mobility, ability to make small purchases, ability to
make larger purchases, relative freedom from domination within the fam-
ily, political and legal awareness, participation in public protests and
political campaigning, and economic security and contribution to family
support.
In rural areas, women's participation in credit programs increases con-
traceptive use. The two main credit organizations bring women together
regularly in groups to discuss such topics as keeping families small and
investing in children's education. Peer pressure may help to achieve
these goals. The authors suggest that programs promoting gender equity
may save money spent on family planning services.
THE THREAT OF "LIFESTYLE DISEASES"
X. Berrios and others, 1997. "Distribution and Prevalence of Major Risk
Factors of Noncommunicable Diseases in Selected Countries: The WHO
Inter-Health Programme." Bulletin of the World Health Organization,
Volume 75, no. 2, pages 99-108.
Important health changes are taking place in developing countries: fer-
tility rates are going down, as are infant and maternal mortality, com-
municable diseases, and general mortality. In most developing countries,
fewer people die from communicable diseases and more die from "chronic
noncommunicable diseases," which are more prevalent among older people,
and from injuries. And, in many countries, the so-called "lifestyle
diseases" are becoming a major threat to human development.
During the last few decades, public health research has shown that cer-
tain measurable risk factors have a major role in retarding human devel-
opment in most world areas: smoking, obesity, high blood pressure, and
high total serum cholesterol. Developed countries show the risk factors
much more than developing countries, but the latter seem bent upon
catching up with the more affluent countries. For example, common risk
factors are already present among young people in developing countries.
The authors (Catholic University of Chile, Santiago) say "the only
rational way to tackle the problem is through prevention activities,
which should be aimed at promoting healthy lifestyles and healthy
environments."
DISASTER RELIEF: WHAT WENT WRONG?
John Birton (ed.), 1996. "Masking a Policy Vacuum? Reviewing the Lessons
of the International Response to the Rwanda Crisis." Disasters, Volume
20, no. 4 (Special Issue), pages 279-352. Six papers.
What went wrong? From April to July 1994 an estimated 500,000 to 800,000
people were slaughtered in the incredibly efficient genocide in Rwanda.
The international community that was supposed to head off disasters and
provide relief was unprepared to do its job. Now, four independent and
thorough studies have been published, which have pinpointed the key fac-
tors in this tragic episode.
According to Howard Adelman (York University, Toronto, Canada) and Astri
Suhrke (Christian Michelsen Institute, Norway), there were clear warn-
ings by the head of the UN peace-keeping force of an impending catastro-
phe. Despite their formal obligations, the international community and
the Security Council scaled down the peace-keeping operation when it was
most critically needed.
Why did the relief operations perform so ineffectively? According to the
analyses, this happened because relief did not, and cannot, substitute
for political action. As Joanna Macrae (Disasters magazine) bluntly puts
it, "... without political and military action to prevent the genocide
and to provide a comprehensive framework for protection, all that relief
aid could do was to pick up the pieces."
O r g a n i z a t i o n s
TROPICAL AGRICULTURE
The Tropical Agricultural Research and Training Center (Turrialba, Costa
Rica), known by its Spanish acronym, CATIE, is a nonprofit agricultural
association for research and education on animal, plant crop, and for-
estry production in the American tropics, established in 1973. It aims
to stimulate and promote the sustainable use of resources. To this end,
it emphasizes tropical crops, watersheds and agroforestry, silviculture,
biodiversity, and socioeconomics. For example, research on tropical
crops includes the improvement of the genetic makeup of coffee, cacao,
plantain, and other promising crops so that they become more productive
and resistant to pests and diseases.
To ensure that it can contribute to sustainability it is studying social
and economic factors that affect natural resource management and ways to
encourage community participation in biodiversity conservation efforts.
The center is the oldest postgraduate center in Latin America and the
Caribbean in tropical agriculture and integrated management of natural
resources. It offers graduate courses leading to masters and doctoral
degrees, and a doctoral program in tropical forestry. If offers inten-
sive, shorter courses on a variety of topics; 1997 topics include trop-
ical agriculture, geographic information systems, information resources
for agriculture, and women in development.
CATIE has been designated by the UN Environmental Programme as the pri-
mary institution working on Environmental and Sustainability Indicators
in Costa Rica. Its Web site provides detailed program information and is
a regional server for the International Union of Forestry Research
Organizations.
Information: Rodrigo Tarte Ponce, Office of the Director General, CATIE,
Turrialba 7170, Costa Rica; tel. +506 561533; fax +506 561533; URL
(English and Spanish): <http://www.catie.ac.cr>.
V I T A P r o j e c t s
REACHING OUT TO WOMEN IN MOROCCO
Like most international development organizations these days, VITA
encourages equal participation of women in activities that improve the
quality of their lives and those of their families. But in Morocco, VITA
is learning that this goal can present challenges.
"From its beginnings six months ago, VITA's Micro Finance Activity here
in Morocco was designed to give men and women microentrepreneurs equal
access to credit," says Paul Rippey, the project director. Although the
total number of loans (500) is ahead of schedule, the proportion given
to women (6%) has been disappointingly low.
Why are so few women getting loans? Rippey replies: "Our first location,
the city of Fez, is one of the more traditional Moroccan cities, where
women's economic independence is very limited. Moreover, women tend to
work mostly at home with other family members. They have trouble assemb-
ling the solidarity group of five nonrelated members, which is a project
requirement for the extension of loans."
The design of the project was sensitive to norms that inhibit the par-
ticipation of women. For example, the Moroccan Code of Personal Status
regulates the status of women in the family. It places them under the
tutorship of their father or husband and limits their control over or
ownership of household properties. The VITA design team used surveys and
interviews with men and women to inform them about program goals and
participation. Rippey believes the program design was basically correct,
but now needs adjustments based on experience.
"We have hired more female credit agents: six of our 18 credit agents
are now women. We also have reduced the minimum loan from $100 to $50.
These changes will make it easier for women borrowers to get their hus-
bands' support for the loans they need." The project is also working
more closely with women's nongovernmental organizations and talking to
both male and female clients about increasing the number of women who
might benefit from project services. Finally, it has changed its slogan
from "Our clients are hard working, honest, capable, and committed" to
"Our clients, men and women, are hard working, honest, capable, and
committed."
"We believe that these efforts will pay off and are confident that as
the project matures it will gradually extend more loans to women. Next
week we will open a new office in Marrakech," says Rippey. "Reports from
our credit agents there indicate that about 20% of the first applicants
will be women."
Information: Barbra Bucci <mailto:bbucci@vita.org>.
A n n o u n c e m e n t s
EMERGING INFECTIOUS DISEASES
Global scientific and public health issues on emerging infectious dis-
eases are the focus of a major meeting entitled, "International Confer-
ence on Emerging Infectious Diseases," to be held 8 to 17 March 1998 at
the Marriott Marquis Hotel in Atlanta, Georgia (USA). The meeting will
highlight programs and activities, identify program gaps, increase pro-
fessional awareness of issues, and enhance partnerships in addressing
the issues. The program includes plenary sessions, symposia by invited
speakers, presentations of current activities, poster sessions based on
submitted abstracts, and exhibits.
Proceedings will be published in the Emerging Infectious Diseases
Journal. Abstracts must be submitted by 31 October 1997. Registration is
limited to 2,500 persons. Information on abstracts, registration, etc.
from the sources listed below. The meeting is primarily sponsored by the
U.S. Centers for Disease Control and Prevention.
Information: Lori Feinman, tel. +1 (202) 942-9248; e-mail <mailto:info@asmusa
.org>; URL <http://www.cdc.gov/ncidod/eidann.html>.
EDUCATION FOR DEVELOPMENT
The Third UNESCO-ACEID International Conference: Educational Innovation
for Sustainable Development is the title of a conference to be held in
Bangkok, Thailand, 1 to 4 December 1997. In addition to its main topic,
the conference will address such subjects as education and economic
development, capacity building and manpower planning, literacy and basic
education as tools for poverty eradication, women's education and devel-
opment, and the role of communities in education for development. It
will feature plenary panel presentations, round tables, concurrent paper
sessions, and an educational fair. It will interest education policy
makers, research workers, and practitioners in research and development.
The conference will take place at the Imperial Queen's Park Hotel and
will be conducted in English. Submitted papers are welcome; abstracts
will be published. The deadline for registration for the conference is
31 October, with a reduced rate for payment before 31 August. Abstracts
prepared according to guidelines must be received by 31 October. Finan-
cial assistance is available for some invited participants.
The conference is being organized by the Asia-Pacific Centre of Educa-
tional Innovation for Development and the Asia-Pacific Programme of Edu-
cation for All, together with the Office of the National Education Com-
mission of Thailand and the UNESCO Principal Regional Office for Asia
and the Pacific.
Information: Rupert Maclean, UNESCO-ACEID, P.O. Box 967, Prakanong Post
Office, Bangkok 10110, Thailand. Tel. +66 (2) 391-0291, ext. 123 or 131;
fax +66 (2) 391-0866; e-mail <mailto:rmaclean@mozart.inet.co.th>.
* * *
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* * *
DevelopNet News is an electronic newsletter published monthly by Volun-
teers in Technical Assistance (VITA), a private, nonprofit, interna-
tional development organization located in Arlington, Virginia. The
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President: Henry R. Norman <mailto:hnorman@vita.org>
Editor: Vicki Tsiliopoulos <mailto:vickit@vita.org>
Editorial Assistant: Rafe Ronkin, VITA Volunteer <mailto:rronkin@vita.org>
VITA specializes in information dissemination and communications tech-
nology. It offers services related to sustainable agriculture, food
processing, renewable energy applications, water sanitation and supply,
small enterprise development, and information management. It has pro-
jects in 6 African countries.
VITA's publications, on a variety of practical subjects, are designed to
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VITA's on-line information services: 24-hr BBS: +1 (703) 527-1086 [9600,
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